Tranexamic acid

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Tranexamic acid
Tranexamic acid Structural Formulae.png
Tranexamic acid ball-and-stick.png
Systematic (IUPAC) name
trans-4-(aminomethyl)cyclohexanecarboxylic acid
Clinical data
Pronunciation \ˌtran-eks-ˌam-ik-\
AHFS/ Consumer Drug Information
  • B
Legal status
  • P (UK)
Routes of
Injection and oral
Pharmacokinetic data
Bioavailability 34%
Biological half-life 3.1 h
CAS Number 1197-18-8 YesY
ATC code B02AA02
PubChem CID 5526
DrugBank DB00302 YesY
ChemSpider 10482000 YesY
UNII 6T84R30KC1 YesY
KEGG D01136 YesY
ChEBI CHEBI:48669 YesY
Chemical data
Formula C8H15NO2
Molar mass 157.21 g/mol

Tranexamic acid (TXA) is used to treat or prevent excessive blood loss from trauma, surgery, and in various medical conditions including hemophilia and heavy menstrual bleeding.[1] It comes in oral and intravenous forms.[1]

Side effects are uncommon and include gastrointestinal effects, dizziness, fatigue, headache, and hypersensitivity reactions.[2] This medication needs to be used cautiously in people with kidney disease and who are at a high risk for blood clots.[1] Tranexamic is safe to use in pregnant women. However, caution should be used in lactating women.[1]

It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[3]

Medical uses[edit]

Tranexamic acid is frequently used following major trauma.[4] Tranexamic acid is used to prevent and treat blood loss in a variety of situations, such as dental procedures for hemophiliacs, heavy menstrual bleeding, and surgeries with high risk of blood loss.[5][6]


Tranexamic acid has been found to decrease the risk of death in people who have significant bleeding due to trauma.[7] However, its benefit only appears to be within the first three hours.[8]

Heavy menstrual bleeding[edit]

Tranexamic acid is used treat heavy menstrual bleeding.[6] When taken by mouth it both safely and effectively treats regularly occurring heavy menstrual bleeding.[2][9] Another study demonstrated that the dose does not need to be adjusted in people who are between ages 12 and 16.[2]


Tranexamic acid is used in orthopedic surgery to reduce blood loss, to the extent of reducing or altogether abolishing the need for perioperative blood collection. It is of proven value in clearing the field of surgery and reducing blood loss when given before or after surgery. Drain and number of transfusions are reduced. However, the hidden blood loss is not reduced. Still, it is becoming an important tool in the anaesthetist's arsenal. It is commonly used in joint replacement surgery.

Use of tranexamic acid in surgical corrections of craniosynostosis in children reduces the need for blood transfusions.[10]

Tranexamic acid is commonly used in cardiac surgery, both with and without cardiopulmonary bypass. It replaces aprotinin.


In the United States, tranexamic acid is FDA approved for short-term use in people with severe bleeding disorders who are about to have dental surgery.[1] Tranexamic acid is used for a short period of time before and after the surgery to prevent major blood loss and decrease the need for blood transfusions.[11] In people with hemophilia, combinations of tranexamic acid and factor VII or IX have effectively decreased blood loss and the need for transfusions after dental surgery In one person with mild hemophilia, a combination of tranexamic acid and demopressin effectively stopped bleeding[12]

Tranexamic acid is used in dentistry in the form of a 5% mouth rinse after extractions or surgery in patients with prolonged bleeding time, e.g. from acquired or inherited disorders.

Other uses[edit]

  • In obstetrics, tranexamic acid is used after delivery to reduce bleeding, often with syntocinon/oxytocin and fundal massage. A major trial is in progress worldwide to establish the efficacy of the drug to arrest postpartum haemorrhage (PPH). Since the drug can be administered orally, it has great potential to reduce maternal mortality rates in developing countries where primary healthcare is often unavailable.
  • In cardiac surgery, e.g. coronary artery bypass surgery, it is used to prevent excessive blood loss.
  • In spine surgery, e.g. scoliosis correction with posterior spinal fusion using instrumentation, to prevent excessive blood loss.[13]
  • In hereditary angioedema[14]
  • In hereditary hemorrhagic telangiectasia - Tranexamic acid has been shown to reduce frequency of epistaxis in patients suffering severe and frequent nosebleed episodes from hereditary hemorrhagic telangiectasia.[15]
  • In melasma - Tranexamic acid has shown to provide rapid and sustained lightening in melasma by decreasing melanogenesis in epidermal melanocytes.[16]
  • In hyphema - Tranexamic acid has been shown to be effective in reducing risk of secondary hemorrhage outcomes in patients with traumatic hyphema.[17]

Adverse effects[edit]

Common side effects include:[2]

  • Headaches (50.4 - 60.4%)
  • Back aches (20.7 - 31.4%)
  • Nasal sinus problem (25.4%)
  • Abdominal pain (12 - 19.8%)
  • Diarrhea (12.2%)
  • Fatigue (5.2%)
  • Anemia (5.6%)

Rare side effects include:[2]

These rare side effects were reported in post marketing experience and frequencies cannot be determined.[2]

Special populations[edit]

  • Tranexamic acid is categorized as pregnancy category B. No harm has been found in animal studies.[2]
  • Small amounts appears in breast milk if taken during lactation.[2]
  • Tranexamic acid is not indicated for lactating women and is not well studied nor intended for use in premenarchial girls (<12 years of age).[2]
  • Tranexamic acid is also not indicated for postmenopausal women and geriatrics.[2]
  • In kidney impairment, tranexamic acid is not well studied. However, due to the fact that it is 95% excreted unchanged in the urine, it should be dose adjusted in patients with renal impairment.[2]
  • In liver impairment, dose change is not needed as only a small amount of the drug is metabolized through the liver.[2]

Mechanism of action[edit]

Tranexamic acid is a synthetic analog of the amino acid lysine. It serves as an antifibrinolytic by reversibly binding four to five lysine receptor sites on plasminogen or plasmin. This prevents plasmin from binding to and degrading fibrin and preserves the framework of fibrin's matrix structure.[2] Tranexamic acid has roughly eight times the antifibrinolytic activity of an older analogue, ε-aminocaproic acid.

Society and culture[edit]

TXA has been included in the WHO list of essential medicines.[3] TXA is inexpensive and treatment would be considered highly cost effective in high, middle and low income countries.[18]

Brand names[edit]

Tranexamic acid is marketed in the U.S. and Australia in tablet form as Lysteda and in IV form as Cyklokapron and Transamin, in the UK as Cyclo-F and Femstrual, in Asia as Transcam, in Bangladesh as Traxyl, in India as Pause, in South America as Espercil, in Japan as Nicolda, in France and Romania as Exacyl and in Egypt as Kapron. In the Philippines, its capsule form is marketed as Hemostan and In Israel as Hexakapron.


The U.S. Food and Drug Administration (FDA) approved tranexamic acid oral tablets (brand name Lysteda) for treatment of heavy menstrual bleeding on 13 November 2009.

In March 2011 the status of tranexamic acid for treatment of heavy menstrual bleeding was changed in the UK, from PoM (Prescription only Medicines) to P (Pharmacy Medicines)[19] and became available over the counter in UK pharmacies under the brand names of Cyklo-F and Femstrual, initially exclusively for Boots pharmacy, which has sparked some discussion about availability.[20] (In parts of Europe - like Sweden - it had then been available OTC for over a decade.) Regular liver function tests are recommended when using tranexamic acid over a long period of time.[21]


  1. ^ a b c d e "Cyklokapron (tranexamic acid) Product Information" (PDF). Retrieved 3 November 2015. 
  2. ^ a b c d e f g h i j k l m "Lysteda (tranexamic acid) Package Insert" (PDF). Retrieved 2 November 2015. 
  3. ^ a b "19th WHO Model List of Essential Medicines (April 2015)" (PDF). WHO. April 2015. Retrieved May 10, 2015. 
  4. ^ Binz, S; McCollester, J; Thomas, S; Miller, J; Pohlman, T; Waxman, D; Shariff, F; Tracy, R; Walsh, M (2015). "CRASH-2 Study of Tranexamic Acid to Treat Bleeding in Trauma Patients: A Controversy Fueled by Science and Social Media.". Journal of blood transfusion 2015: 874920. doi:10.1155/2015/874920. PMID 26448897. 
  5. ^ Melvin, JS; Stryker, LS; Sierra, RJ (22 October 2015). "Tranexamic Acid in Hip and Knee Arthroplasty.". The Journal of the American Academy of Orthopaedic Surgeons 23: 732–40. doi:10.5435/JAAOS-D-14-00223. PMID 26493971. 
  6. ^ a b Tengborn, L; Blombäck, M; Berntorp, E (February 2015). "Tranexamic acid--an old drug still going strong and making a revival.". Thrombosis research 135 (2): 231–42. doi:10.1016/j.thromres.2014.11.012. PMID 25559460. 
  7. ^ Cherkas, David (Nov 2011). "Traumatic Hemorrhagic Shock: Advances In Fluid Management". Emergency Medicine Practice 13 (11). 
  8. ^ Napolitano, Lena M.; Cohen, Mitchell J.; Cotton, Bryan A.; Schreiber, Martin A.; Moore, Ernest E. (2013). "Tranexamic acid in trauma". Journal of Trauma and Acute Care Surgery 74 (6): 1575–86. doi:10.1097/TA.0b013e318292cc54. PMID 23694890. 
  9. ^ Lukes, AS; Moore, KA; Muse, KN (2010). "Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial". Obstet Gynecol 116 (4): 865–875. doi:10.2147/IJWH.S13840. PMC 3430088. PMID 22956886. 
  10. ^ RCPCH. "Evidence Statement Major trauma and the use of tranexamic acid in children Nov 2012" (PDF). Retrieved 17 December 2012. 
  11. ^ Forbes CD, Barr RD, Reid G; et al. (1972). "Tranexamic acid in control of haemorrhage after dental extraction in haemophilia and Christmas disease". Br Med J 2 (5809): 311–313. doi:10.1136/bmj.2.5809.311. 
  12. ^ Shankar S & Lee R (1984). "DDAVP and tranexamic acid for dental extractions in a mild hemophiliac". Br Dent J 156 (12): 450–452. doi:10.1038/sj.bdj.4805387. 
  13. ^ Sethna, N. F.; Zurakowski, D; Brustowicz, R. M.; Bacsik, J; Sullivan, L. J.; Shapiro, F (2005). "Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery". Anesthesiology 102 (4): 727–32. doi:10.1097/00000542-200504000-00006. PMID 15791100. 
  14. ^ Rod Flower; Humphrey P. Rang; Maureen M. Dale; Ritter, James M. (2007). Rang & Dale's pharmacology. Edinburgh: Churchill Livingstone. ISBN 0-443-06911-5. [page needed]
  15. ^ Klepfish, A; Berrebi, A; Schattner, A (2001). "Intranasal tranexamic acid treatment for severe epistaxis in hereditary hemorrhagic telangiectasia". Archives of Internal Medicine 161 (5): 767. doi:10.1001/archinte.161.5.767. PMID 11231712. 
  16. ^ Karn, D; Kc, S; Amatya, A; Razouria, E. A.; Timalsina, M (2012). "Oral tranexamic acid for the treatment of melasma". Kathmandu University Medical Journal 10 (40): 40–3. doi:10.3126/kumj.v10i4.10993. PMID 23575051. 
  17. ^ Gharaibeh, Almutez; Savage, Howard I; Scherer, Roberta W; Goldberg, Morton F; Lindsley, Kristina (2011). "Medical interventions for traumatic hyphema". Cochrane Database of Systematic Reviews (1): CD005431. doi:10.1002/14651858.CD005431.pub2. PMC 3437611. PMID 21249670. 
  18. ^ Guerriero, Carla; Cairns, John; Perel, Pablo; Shakur, Haleema; Roberts, Ian; Crash 2 Trial, Collaborators (2011). "Cost-Effectiveness Analysis of Administering Tranexamic Acid to Bleeding Trauma Patients Using Evidence from the CRASH-2 Trial". PLoS ONE 6 (5): e18987. Bibcode:2011PLoSO...618987G. doi:10.1371/journal.pone.0018987. PMC 3086904. PMID 21559279. 
  19. ^ Tranexamic Acid to be available OtC[full citation needed]
  20. ^ In defence of multiple pharmacies[full citation needed]
  21. ^ Allen, Helen (June 13, 2012). "Tranexamic acid for bleeding". Patient UK. 

External links[edit]